6:260-E2 Challenge of Instructional Materials
Please complete this form and return it to the Building Principal who will submit it to the District Complaint Manager. Please print or type.
Format of Material: _______________________________________
Subject Area: _______________________________________
1. Did you review the entire material? _____Yes _____No
2. Did you discuss the use of the material in the instructional program with school personnel? _____Yes _____No
3. Please state, as precisely as possible, to what in the material you object.
4. In your opinion, what negative effects might result from the use of this material with students?
5. Do you perceive any educational benefit for students resulting in the use of this material?
6. Is there any age group of students for which you would recommend this material?
Complaintant name (please print): ____________________________________
Complaintant represents: _____Student _____Parent/guardian of student _____Other
Complaintant address: ______________________________________
Signature of complaintant : ________________________________
Date Approved: April 10, 2007